Posts from the ‘Perspectives on Culture and Mental Health’ Category

Recently a viral You Tube video by an uncreative comedian brought some internet attention onto the concept of fat shaming. I won’t give the person’s name or details of the video, I’m sure most of you have an idea of the video I’m speaking about and I don’t want to encourage any more clicks to her website or contribute to any attention she is getting in the aftermath of this video. There is plenty to say about the myths about tough love and fat shaming without this poorly done video being attached to it.

There is a line of thought in mainstream culture that suggests that being “tough” on people who are overweight will lead to positive changes in their lifestyle (aka weight loss). Somehow society has taken on the responsibility of being truth-bomb-droppers for overweight and obese people, criticizing their body size under the guise of “helping”. This is exasperating to me on many levels and brings up a lot of discussion points (I could go on all day, but I’ll spare everyone the excess ranting and stick to my Top Three);

1) The idea that criticizing another person for their weight is somehow going to inspire them to lose weight is inaccurate and misguided. In the book “Health at Every Size”, Linda Bacon summarizes numerous research studies that show that people who are criticized for their weight tend to gain MORE weight and at a high risk for becoming obese. I’m not sure how the message got out there that people who are overweight are somehow unaware of their size and need this to be pointed out by another person. Who needs a “truth bomb” from a stranger on the internet when you are the one living in your body every day? If it doesn’t result in any positive lifestyle changes, then the point of this criticism is more beneficial to the person criticizing than the person receiving the so-called truth bomb. People who intend for this to be helpful call it “tough love”, but it is just plain old body shaming. The recipient tends to internalize all of the “tough” and none of the “love”.

2) In my professional experience as a therapist who specializes in the treatment of eating disorders, the presence of body shaming is a response to the collective fear we have of body acceptance.The idea that we can accept our bodies (Yes, even if we are not at our lowest, ideal weight. Stay with me.) is a tough pill for most people to swallow. Acceptance is not the same as giving up. Acceptance actually leads to more positive changes and is a powerful motivator. It is the thing that leads us to exercise for the good feeling it gives us, not as a punishment for “bad” eating. It leads to us choosing foods that make our bodies feel healthy and energized. There is a lot of fear that if a person fully accepts themselves, than they will become lazy and out of control. You know what sends people into a state of feeling and acting out of control? Anxiety. Shame. Trauma. All of these triggers are products of internalized criticism, not self-acceptance.

3) How do we know that weight loss is the secret to good health for others? How can we tell, just by looking at a person, that their weight is unhealthy? Only a doctor can make that conclusion about an individual. There is medical research (again, please consult the book, “Health at Every Size”) that states that people whose BMI lands in the “overweight” range actually live longer than people whose weight land in the “normal” range. Our bodies are designed to store fat as a survival mechanism, we don’t need to demonize this basic biological function, we need a more in-depth understanding of it. More medical information has been surfacing that shows that it’s healthy habits, not body size, that determines better health outcomes and longer lifespans. I encourage anyone interested in learning more to check out the the TED talk given by Sandra Aamodt, MD. There is a wealth of solid science out there that challenges this black and white idea that weight is a primary indicator of health. It is one fraction of a much more complex picture. We need to stop treating others like we have all the answers for them, just based on their body size.

I hope the conversation about fat shaming can move beyond the arena of who is offended, who is too sensitive, and who should or shouldn’t have opinions about being overweight. These are all part of the same smokescreen hiding the real issue; fat shaming is real, it is damaging and it isn’t inspiring anyone to make positive changes. Let’s do more to help people feel like they can trust themselves and make their own intuitive judgment calls about their health choices without being criticized. Let’s. Do. More.

There has been a lot of talk around the term “Orthorexia Nervosa”. It is defined by Steven Bratman, MD, as, “an unhealthy obsession with eating healthy food”. While this disorder is not officially part of the DSM-V as an official Eating Disorder, it still produces a great deal of pain for those who suffer from it and is worth the attention of the mental health community.

As a therapist who specializes in the treatment of Eating Disorders, this condition is not new to me. I have been seeing it for years, it only now has a name attached to it. I believe it is vital for our culture to start looking more critically at what it means to be “healthy”. Many people develop some kind of disordered eating habits or full-fledged eating disorders with the intention of being “healthy”. Somewhere along the way, things take a turn and these good intentions become harmful behaviors, but the intention is almost always coming from a place of wanting to be healthier or improve oneself. I want to look at Orthorexia through this compassionate lens.

The key to understanding what makes this a disorder different from “healthy eating” is a person’s rigidity of thinking and the level of distress that one experiences when deviations from that diet are made. Making solid efforts to eat healthy food is not what makes Orthorexia a disorder. One person could eat the exact same organic kale salad and it isn’t necessarily the food choice itself but the thoughts and anxiety behind it that make it a disorder. If a person is not able to be flexible with food choices, a serious red flag goes up for me in thinking that this person is at high risk for some kind of Eating Disorder. We deal with many unexpected events in the course of our lives, from life-changing, traumatic disruptions to smaller but still significant disruptions in our everyday routine. Allowing our brains to accept this uncertainty and be able to adapt to new circumstances is a huge part of being an emotionally healthy person. For a person with Orthorexia, deviations from his/her routine that are food related are met with intense guilt, anxiety, and self-criticism. Being at a party and being “forced” to eat outside of his/her comfort zone is not something that is acceptable to a person with Orthorexia. The focus of everyday life is about maintaining the “purity” of his/her diet and removes the person from fully being present. Planning meals for the day begins to take up more and more time. A person starts saying no to social engagements or travel because they are unsure of the food that will be available. When a person must deviate from the food plan, the level of anxiety that it triggers is painful. This is much more than a simple, “Oh wow, I think I overate at that party, I’ll just balance things out tomorrow”. The thoughts are more focused on personal weakness or “what damage has been done”. Weight loss is not the main goal for the person with Orthorexia, the focus is on food purity.

What makes this such a difficult issue to address is the good intentions of the person suffering from the disorder and how difficult it is for others to understand why this is a problem. Maybe the person is focused on eliminating carcinogens to avoid cancer, or eliminate chemicals from their diets. These goals start off well, but the time involved to succeed at them becomes more than a person can realistically commit to. It also becomes tied to a person’s self-esteem. Food is important and it can bring up a lot of emotions for us, but it is not tied to our self-worth. A person with Orthorexia often judges him/herself based on their food choices. That organic kale salad goes from being a simple lunch choice becoming a source of personal validation. When the person “falls off the wagon”, the shame is so intense that it furthers a tendency to isolate and become disengaged with life outside of the world of Food. It can also have physical consequences, including nutritional deficiencies and illness.

When I read articles on Orthorexia on social media sites, I am often struck with the backlash that I read from people who are outraged that “healthy eating is now a disorder”. I hope we can expand our dialogue here. This is an opportunity to have an honest look at what “good health” means. I hope that we can acknowledge that we are allowed to choose how we spend our time. We are allowed to spend time fostering relationships, working on our careers and finding joy in our lives. The purity of our food choices does not have to take priority over all of these other things. We are allowed to listen to our bodies and make intuitive food choices based on our healthy hunger cues. We are not “weak” or “bad” when we don’t execute these diets perfectly. There is a big difference between “eating perfectly” and having a balanced life that is focused on flourishing. I hope we can continue to strive for this and support others who are struggling to do so through their eating disorders.

“I was on Facebook last night, and now I feel so frustrated, it seems like everyone else has their life together but me”. As a therapist in the age of social media, these kinds of statements are heard frequently in my office. Most of us take part in social media, like Facebook, for many good reasons. We can keep in touch with relatives and friends all over the world, we can stay updated with causes and organizations that we find meaningful, we can reconnect with old friends and meet new people with similar interests as our own, and we can share milestones. There have been many questions raised about using Facebook, some psychologists worry that increased time online leads to social isolation, or overstimulation and a decreased ability to focus. I think that one overlooked question is related to something more personal: Why does Facebook make us feel bad about ourselves? Why can a half hour on Facebook result in hours or days of us berating ourselves for the life choices we made, or make us feel depressed about what we are not accomplishing? I thought Facebook was supposed to be enjoyable… what happened?

I think we need to look at the significance of social comparison in order to address this growing problem. Social Psychologist Leon Festinger developed the Social Comparison Theory that was revolutionary in the 1950s and is still highly relevant today. His theory states that humans have a significant internal drive to look for outside images in order to evaluate their own abilities and opinions. We look to these images provided by others to be realistic and obtainable, which means that even if an image is idealized, we interpret them as obtainable, which can lead to emotional responses. We are programmed to look at what others are doing and then evaluate ourselves to see if we “measure up”. Facebook, with constant status updates and endless photos being uploaded multiple times per day, is providing us social comparison opportunities on steroids. It can become a very legitimate and powerful source of stress, leading to feelings of guilt, frustration, and it can bring up anxiety-provoking questions about ourselves: “Why can’t I spend the summer backpacking in southeast Asia? How on Earth did my high school boyfriend manage to become a CEO at age 25 and I’m still figuring out what do to with my life at 35? Why can’t I train my cat to play the piano? I wish I could afford to buy a new home, will I ever be financially stable enough to do that? Everyone is posting pictures of their new babies, is something wrong with me that I don’t want to have a baby yet but all of my friends do? Am I behind???”.

Facebook is a forum for us to carefully choose what images we put out there into the world. Most people tend to choose the “best” images to post; the funniest moments, the most flattering portraits, the most interesting updates. It is entirely unrealistic for us to see a Facebook profile and to assume that the person behind it is really living an idealistic or perfect life. Very few people are posting photos of their kids screaming while in line at the grocery store, or photos of themselves getting into fights with their partners, or status updates that talk about getting laid off and the panic of not knowing what to do next. I believe it is important to see social media for what it is, and not use it as a tool to evaluate our lives to see if we are “measuring up” or not. The next time you find yourself comparing yourself to friends on Facebook, acknowledge that your response is understandable and normal, but it is not a valid reason to be hard on yourself or feel guilty for your life decisions. Try logging off of Facebook for a day and give yourself permission to focus on yourself without comparing yourself to others. It can be a surprisingly positive break.

About

Erika Hirsch, MA, MFT, ATR is a licensed California Marriage and Family Therapist, license number MFC45824, and a Registered Art Therapist through the Art Therapy Credentials Board, Inc.
The logo and illustrations featured on this website were created by Julia Humpfer Illustration, www.juliahumpfer.com